Morphologic analysis of the proximal tibia after open wedge high tibial osteotomy for proper plate fitting View Full Text


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Article Info

DATE

2016-10-10

AUTHORS

Oui Sik Yoo, Yong Seuk Lee, Myung Chul Lee, Jae Hong Park, Jae Won Kim, Doo Hoon Sun

ABSTRACT

BackgroundAfter open wedge high tibial osteotomy (OWHTO), the proximal fragment resembles the anatomy of the proximal tibia that is aligned in the anterior-posterior direction and the distal fragment resembles the anatomy of the mid shaft that is aligned in the proximal-distal direction. In addition, the medial portion of the proximal fragment becomes aligned medially and the medial portion of the distal fragment, laterally, depending on the magnitude of the posterior opening gap. Therefore, there would be a mismatch between the post-correction bony surface and the previous pre-contoured plate geometry. The purpose of this study was to devise a new plate that best fit the post-contoured anatomy of the tibia by evaluating the surface geometry of the plate positioning site after OWHTO.MethodsThirty-one uni-planar and 38 bi-planar osteotomies were evaluated. Surgical indications were age of under 70 years, relatively active patient who performs recreational sports activities. Other indications were similar with general recommendation of HTO. Computed tomography (CT) of the operated knees was performed and it was used for the reconstruction of the 3D model. Bone model axis re-alignment was performed with coronal, sagittal, and axial plane. Morphologic analysis of the proximal tibia was performed using the following parameters: (1) radii in axial plane, 2) radii in coronal plane, and 3) angle and horizontal distance (Distance X) between the proximal and distal fragments. These were also analyzed according to the correction degree. The Analysis of Variance (ANOVA) test was conducted to verify the change depending on the correction amount of the posterior opening gap. The values obtained for the uni- and bi-planar osteotomy were compared by the independent t-test.ResultsThere were 9 male and 60 female patients were recruited to this study; the mean age was 58.3 ± 8 and 56.9 ± 7.6 years, respectively. Preoperative weight bearing line (WBL) was 21.59 ± 11.36 and 22.32 ± 10.55 %, respectively. Mean correction degree was 10.9 ± 2.7 and 11.1 ± 2.6 mm, respectively. The radii of the tibial cross-sectional contour at the head portion tended to increase from the proximal to distal direction. The radii of the tibial cross-sectional contour at the neck portion tended to decrease from the proximal to distal direction. The radii of the coronal plane tended to increase from the proximal to distal direction. The angle between the proximal fragment and the distal one varied with the correction amount of the posterior opening gap. Shaft_Mid and Distance X of GroupI (110.08 mm and 6.11 mm, respectively) which had lower correction angle were lower than those of GroupII (130.05 mm and 6.41 mm, respectively) and those of GroupIII (136.35 mm, 8.01 mm, respectively) in coronal plane. There were significant differences (p = 0.023 < 0.05 and p = 0.009 < 0.01, respectively).ConclusionCurrent plate design should be modified to the surface geometry of the post-correction for the proper fitting. As the correction degree increases, the plate should be bended at the both end of the opening gap in coronal plane.Trial registration‘retrospectively registered (ISRCTN97792440). More... »

PAGES

423

References to SciGraph publications

  • 2012-05-31. High Tibial Osteotomy in KNEE SURGERY & RELATED RESEARCH
  • 2009-02-03. Stability of medial opening wedge high tibial osteotomy: a failure analysis in INTERNATIONAL ORTHOPAEDICS
  • 2014-08-29. Biomechanical Properties of a New Anatomical Locking Metal Block Plate for Opening Wedge High Tibial Osteotomy: Uniplane Osteotomy in KNEE SURGERY & RELATED RESEARCH
  • 2005-11-12. Primary stability of four different implants for opening wedge high tibial osteotomy in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 2014-10-27. Comparative analysis of osteotomy accuracy between the conventional and devised technique using a protective cutting system in medial open-wedge high tibial osteotomy in JOURNAL OF ORTHOPAEDIC SCIENCE
  • 2013-02-06. Lateral tibial bone mineral density around the level of the proximal tibiofibular joint in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 2012-07-07. Biomechanics of high tibial osteotomy in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 2014-01-30. No correction angle loss with stable plates in open-wedge high tibial osteotomy in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 2014-02-22. A matched-pair comparison of two different locking plates for valgus-producing medial open-wedge high tibial osteotomy: peek–carbon composite plate versus titanium plate in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 2013-10-12. Reliability of the imaging software in the preoperative planning of the open-wedge high tibial osteotomy in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • Identifiers

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    http://scigraph.springernature.com/pub.10.1186/s12891-016-1277-3

    DOI

    http://dx.doi.org/10.1186/s12891-016-1277-3

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1011241047

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/27724861


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        "description": "BackgroundAfter open wedge high tibial osteotomy (OWHTO), the proximal fragment resembles the anatomy of the proximal tibia that is aligned in the anterior-posterior direction and the distal fragment resembles the anatomy of the mid shaft that is aligned in the proximal-distal direction. In addition, the medial portion of the proximal fragment becomes aligned medially and the medial portion of the distal fragment, laterally, depending on the magnitude of the posterior opening gap. Therefore, there would be a mismatch between the post-correction bony surface and the previous pre-contoured plate geometry. The purpose of this study was to devise a new plate that best fit the post-contoured anatomy of the tibia by evaluating the surface geometry of the plate positioning site after OWHTO.MethodsThirty-one uni-planar and 38 bi-planar osteotomies were evaluated. Surgical indications were age of under 70\u00a0years, relatively active patient who performs recreational sports activities. Other indications were similar with general recommendation of HTO. Computed tomography (CT) of the operated knees was performed and it was used for the reconstruction of the 3D model. Bone model axis re-alignment was performed with coronal, sagittal, and axial plane. Morphologic analysis of the proximal tibia was performed using the following parameters: (1) radii in axial plane, 2) radii in coronal plane, and 3) angle and horizontal distance (Distance X) between the proximal and distal fragments. These were also analyzed according to the correction degree. The Analysis of Variance (ANOVA) test was conducted to verify the change depending on the correction amount of the posterior opening gap. The values obtained for the uni- and bi-planar osteotomy were compared by the independent t-test.ResultsThere were 9 male and 60 female patients were recruited to this study; the mean age was 58.3\u2009\u00b1\u20098 and 56.9\u2009\u00b1\u20097.6\u00a0years, respectively. Preoperative weight bearing line (WBL) was 21.59\u2009\u00b1\u200911.36 and 22.32\u2009\u00b1\u200910.55\u00a0%, respectively. Mean correction degree was 10.9\u2009\u00b1\u20092.7 and 11.1\u2009\u00b1\u20092.6\u00a0mm, respectively. The radii of the tibial cross-sectional contour at the head portion tended to increase from the proximal to distal direction. The radii of the tibial cross-sectional contour at the neck portion tended to decrease from the proximal to distal direction. The radii of the coronal plane tended to increase from the proximal to distal direction. The angle between the proximal fragment and the distal one varied with the correction amount of the posterior opening gap. Shaft_Mid and Distance X of GroupI (110.08\u00a0mm and 6.11\u00a0mm, respectively) which had lower correction angle were lower than those of GroupII (130.05\u00a0mm and 6.41\u00a0mm, respectively) and those of GroupIII (136.35\u00a0mm, 8.01\u00a0mm, respectively) in coronal plane. There were significant differences (p\u2009=\u20090.023\u2009<\u20090.05 and p\u2009=\u20090.009\u2009<\u20090.01, respectively).ConclusionCurrent plate design should be modified to the surface geometry of the post-correction for the proper fitting. As the correction degree increases, the plate should be bended at the both end of the opening gap in coronal plane.Trial registration\u2018retrospectively registered (ISRCTN97792440).", 
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    28 schema:description BackgroundAfter open wedge high tibial osteotomy (OWHTO), the proximal fragment resembles the anatomy of the proximal tibia that is aligned in the anterior-posterior direction and the distal fragment resembles the anatomy of the mid shaft that is aligned in the proximal-distal direction. In addition, the medial portion of the proximal fragment becomes aligned medially and the medial portion of the distal fragment, laterally, depending on the magnitude of the posterior opening gap. Therefore, there would be a mismatch between the post-correction bony surface and the previous pre-contoured plate geometry. The purpose of this study was to devise a new plate that best fit the post-contoured anatomy of the tibia by evaluating the surface geometry of the plate positioning site after OWHTO.MethodsThirty-one uni-planar and 38 bi-planar osteotomies were evaluated. Surgical indications were age of under 70 years, relatively active patient who performs recreational sports activities. Other indications were similar with general recommendation of HTO. Computed tomography (CT) of the operated knees was performed and it was used for the reconstruction of the 3D model. Bone model axis re-alignment was performed with coronal, sagittal, and axial plane. Morphologic analysis of the proximal tibia was performed using the following parameters: (1) radii in axial plane, 2) radii in coronal plane, and 3) angle and horizontal distance (Distance X) between the proximal and distal fragments. These were also analyzed according to the correction degree. The Analysis of Variance (ANOVA) test was conducted to verify the change depending on the correction amount of the posterior opening gap. The values obtained for the uni- and bi-planar osteotomy were compared by the independent t-test.ResultsThere were 9 male and 60 female patients were recruited to this study; the mean age was 58.3 ± 8 and 56.9 ± 7.6 years, respectively. Preoperative weight bearing line (WBL) was 21.59 ± 11.36 and 22.32 ± 10.55 %, respectively. Mean correction degree was 10.9 ± 2.7 and 11.1 ± 2.6 mm, respectively. The radii of the tibial cross-sectional contour at the head portion tended to increase from the proximal to distal direction. The radii of the tibial cross-sectional contour at the neck portion tended to decrease from the proximal to distal direction. The radii of the coronal plane tended to increase from the proximal to distal direction. The angle between the proximal fragment and the distal one varied with the correction amount of the posterior opening gap. Shaft_Mid and Distance X of GroupI (110.08 mm and 6.11 mm, respectively) which had lower correction angle were lower than those of GroupII (130.05 mm and 6.41 mm, respectively) and those of GroupIII (136.35 mm, 8.01 mm, respectively) in coronal plane. There were significant differences (p = 0.023 < 0.05 and p = 0.009 < 0.01, respectively).ConclusionCurrent plate design should be modified to the surface geometry of the post-correction for the proper fitting. As the correction degree increases, the plate should be bended at the both end of the opening gap in coronal plane.Trial registration‘retrospectively registered (ISRCTN97792440).
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    34 schema:keywords GroupIII
    35 HTO
    36 MethodsThirty-one
    37 ResultsThere
    38 Uni
    39 active patients
    40 activity
    41 addition
    42 age
    43 amount
    44 analysis
    45 anatomy
    46 angle
    47 anterior-posterior direction
    48 axial plane
    49 axis
    50 bearing line
    51 bony surface
    52 changes
    53 computed tomography
    54 contours
    55 coronal plane
    56 correction amount
    57 correction angle
    58 correction degree
    59 cross-sectional contours
    60 degree
    61 design
    62 differences
    63 direction
    64 distal direction
    65 distal fragment
    66 distance
    67 distance x
    68 end
    69 female patients
    70 fitting
    71 fragments
    72 gap
    73 general recommendations
    74 geometry
    75 groupI
    76 groupII
    77 head portion
    78 high tibial osteotomy
    79 horizontal distance
    80 independent t-test
    81 indications
    82 knee
    83 lines
    84 magnitude
    85 mean age
    86 medial portion
    87 mid shaft
    88 mismatch
    89 model
    90 model axis
    91 morphologic analysis
    92 neck portion
    93 new plate
    94 open-wedge high tibial osteotomy
    95 opening gap
    96 operated knees
    97 osteotomy
    98 parameters
    99 patients
    100 plane
    101 plate
    102 plate design
    103 plate geometry
    104 portion
    105 positioning sites
    106 posterior opening gap
    107 proper fitting
    108 proximal
    109 proximal fragment
    110 proximal tibia
    111 proximal-distal direction
    112 purpose
    113 radius
    114 recommendations
    115 reconstruction
    116 recreational sports activities
    117 sagittal
    118 shaft
    119 significant differences
    120 sites
    121 sports activities
    122 study
    123 surface
    124 surface geometry
    125 surgical indications
    126 t-test
    127 test
    128 tibia
    129 tibial osteotomy
    130 tomography
    131 trials
    132 values
    133 variance test
    134 wedge high tibial osteotomy
    135 weight-bearing line
    136 years
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